Geriatrics Flashcards
1
Q
What are the CV changes in the geriatric population?
A
-Decrease in elasticity of arteries (less compliant)
-Elevated afterload
-Elevated systolic pressures
-Left ventricular hypertrophy
-Adrenergic activity decreases
-Decreased heart rate both rest and max
-Decreased baroreceptor response
(Will have higher level of catecholamines but have a decreased responsiveness)
2
Q
What age is considered geriatric?
A
65 years- subjective
3
Q
What information will be on an H&P?
A
-Aortic stenosis
-History of arrhythmias
-CHF
-HTN
-CAD
4
Q
How much does heart rate decline over the age of 50?
A
1 beat per min/year
5
Q
Why do older pts have an increased risk of having arrhythmias?
A
D/t conduction system fibrosis and loss of SA node cells
6
Q
Respiratory wise what may geriatric pts complain of?
A
-Exercise intolerance
-SOB
-Fatigue
7
Q
What does atrial enlargement put a geriatric patient at risk for?
A
SVT and A.fib (very common)
8
Q
What causes the decreasing volume of the left ventricular cavity?
A
Left ventricular wall thickness
9
Q
What does the term eccentric mean?
A
Ventricular dilation while maintaining normal sarcomere lengths. Diastolic heart failure.
- The heart can expand to receive a greater volume of blood
-The wall thickness normally increases in proportion to the increase in chamber radius
Reguritation= volume overload= eccentric hypertrophy (chamber/wall dilates)
-sarcomeres added in series
10
Q
What is concentric?
A
Chronic pressure overload (increases resistance to blood flow by compressing arteries), the chamber radius may not change.
-Wall thickness will increase as the sarcomeres are added in parallel to existing sarcomeres
-Stenosis= pressure overload= concentric hypertrophy
(radius of ventricles decreases as wall thickens)
concentric= concrete= thick and hard
11
Q
Will a geriatric pt’s BP increase or decrease during induction?
A
Decrease
- autonomic responses that maintain homeostasis progressively decline= autonomic dysfunction
12
Q
Will circulation with IV drugs increase or decrease?
A
Decrease
13
Q
Will the speed of induction with inhalation agents increase or decrease?
A
Increase (d/t slow circulation)
-Drop dosages by 50%
14
Q
Does MAC increase of decrease?
A
Decrease
(Decreased 6% per decade after age 40)
15
Q
What happens when Beta-receptor response is blunted in the geriatric population?
A
-Decreased maximal heart rate
-Decreased peak ejection fraction
16
Q
What happens when Beta-receptor response is blunted in the geriatric population?
A
-Decreased maximal heart rate
-Decreased peak ejection fraction
17
Q
Is the elderly patient more reliant on HR or end-diastolic volume (preload) to increase cardiac output?
A
End-diastolic volume
18
Q
Why is the elderly pt more prone to congestive heart failure?
A
Bc the pt is more dependent on end-diastolic volume to maintain CO, when large volumes of IVF are given in the presence of anesthetic induced myocardial depression and HoTN, the heart rate can’t keep up to adequately increase CO
19
Q
What are the respiratory changes in the geriatric patient?
A
-Decreased elasticity of lungs= air trapping
-Decreased alveolar surface area
-INCREASED residual volume
-V/Q mismatch (increased dead space)
-Chest wall rigidity
-Decreased cough
-Blunted response to hypercapnia and hypoxia
-Decreased max breathing capacity
-INCREASED closing capacity and closing volume
** lung compliance is increased bc lung expands- but can’t recoil
20
Q
How is maximal heart rate calculated?
A
220-age (with age increasing, they will have a lower HR that they can tolerate)
21
Q
All of the following physiologic parameters decrease in the elderly except
A. Closing volume
B. Renal mass
C. Lean body mass
D. Body water
A
A. Closing volume
Compared with younger adults, the geriatric population have a reduced lean body mass, decreased total body water, decreased serum albumin, decreased kidney mass, and decreased hepatic blood flow. Body fat and closing volume, however, increase with age.
22
Q
Which of the following statements is true of the pharmacokinetic changes seen in the elderly population?
A. They have a higher volume of distribution for succinylcholine
B. They have a lower volume of distribution for glycopyrrolate
C. They have a lower volume of distribution for thiopental
D. They have a lower volume of distribution for midazolam
A
B. They have a lower volume of distribution for glycopyrrolate
In the elderly patient, total body water decreases while total body fat increases. Thus, the volume of distribution for water-soluble drugs such as glycopyrrolate, succinylcholine, and gentamicin decreases while the volume of distribution for lipid-soluble drugs such as barbiturates, benzodiazepines, and volatile anesthetics increases.
23
Q
What changes in the elderly will impact ventilation and intubation and positioning during this time?
A
-May be edentulous= difficulty mask ventilating, but have a better view for laryngoscopy
-Arthritis= difficulty opening mouth and extending neck
-Decreased airway reflexes= increased risk of aspiration
-may have an over distention of alveoli, and collapse of small airways
- shallow breathers, if pre-existing resp disease consider leaving intubated
24
Q
All of the following are potential reasons for delayed recovery from anesthesia in geriatric patients except:
A. Decreased renal function
B. Decreased hepatic function
C. Increased protein binding
D. Increased body fat percentage
A
C. Increased protein binding
Decreased renal function and decreased hepatic function are normal findings in aged patients and can both contribute to a prolonged effect in many drugs. Body fat can act as a reservoir for lipid-soluble drugs which can result in prolongation of their action. Increased protein binding would not necessarily result in a prolonged duration of action of a a drug and furthermore, increased serum protein is not a typical finding in the geriatric population as protein synthesis also diminishes with age.
25
Does FRC increase or decrease?
Increases (slightly)
26
How much does vital capacity decrease and starting at what age?
25ml/year starting at age 20
(d/t chest wall rigidity)
27
Does Residual volume increase or decrease with age? (KNOW ALL RESP CHANGES FOR QUIZ)
Increase
28
What is the impact of age on total lung capacity?
Stays the same (Jerry says decreases)
29
Do the elderly have signs of restrictive, obstructive or both kinds of diseases?
BOTH
30
Does dead space increase or decrease in the elderly?
INCREASE (air trapping)
31
What is the Bohr equation?
Vd/Vt ratio (dead space to tidal volume ratio)
Dead space INCREASES
vd/vt 150ml/450ml= 33%
31
What is the Bohr equation?
Vd/Vt ratio (dead space to tidal volume ratio)
Dead space INCREASES
vd/vt 150ml/450ml= 33%
32
What gastric/GI changes occur in the geriatric population?
-Gastric pH RISES
-Gastric emptying slows
- Some elderly pts have smaller stomach volumes than younger people
33
How does age affect temperature regulation?
-Heat production decreases
-Heat loss increases
34
What things put a geriatric pt at risk for hypothermia?
-Decreased metabolic rate
-Decreased heat production
-Deficient thermostat control
(cold= prolongs the duration of anesthetic)
* don't take bair hugger off until pt is extubated when with Jerry
35
What are some renal changes in the elderly?
-Decreased renal blood flow
-Decreased GFR
-Decreased renal mass
-Impaired sodium handling
-Decreased concentrating abilities
-Decreased dilution
-Impaired fluid handling
-Decreased drug excretion
-Decreased renin-aldosterone response
-Impaired potassium excretion
36
What happens to the renal cortex w age?
Replaced w fat and fibrotic tissue
37
What happens to serum creatinine with age?
It will remain the same d/t decrease in muscle mass and decreased production of creatinine
38
How is BUN impacted?
Gradually increases 0.2% mg/dL per year
39
Why are elderly pts predisposed to dehydration and also fluid overload?
Sodium, diluting and concentration management changes
40
Does glucose reabsorption increase or decrease
Decrease (inability to reabsorb glucose)
41
Why is this age group at increased risk for acute renal failure?
Decreased renal blood flow
42
With the prescription of diuretics which electrolyte is at risk to become hypo/hyper?
Potassium
43
What is considered the most specific test of renal failure?
Serum creatinine clearance (24hr) to assess GFR
(typically decreased in this population d/t decrease renal blood flow)
44
Is cerebral blood flow and brain mass increased or decreased?
Decreased
45
Which neurotransmitter and receptor is decreased int his population?
Dopamine
46
What has been shown to preserve cognitive function in this population?
Physical activity
47
What leads to muscle atrophy is this population?
Degeneration of peripheral nerves slows conduction and reactions
48
Don't give versed to people over the age of:
65
49
Why do older patients often burn themselves?
Increased thresholds (decreased sensitivity) to touch, temperature, and pain)
50
Is the threshold increased or decreased for proprioception, hearing and vision?*****
Increased threshold (decreased sensitivity)
51
Dosages for locals and general anesthetics are _____
Reduced
MAC reduced by 4-6% per decade after the age of 40
52
What kind of spread will an epidural anesthetic have?
Cephalad spread
(lower epidural volume, decreased height, less space btwn intervertebral discs)
Want to decrease dosages for local anesthetics too!
Will also be more sensitive to the locals in spinals d/t decreased volume of CSF (and smaller space)
53
The duration of the block for analgesia and motor will be _____ in this population
Shorter
54
What could you see cognitively right away as the patient is waking up?
Delirium- happens right away
55
Why do the elderly have an increased incidence of confusion delirium and cognitive disruptions following anesthesia?
Related to drug effects, pain, previous dementia, hypoxemia and metabolic disturbances
56
What is a class of medications that the elderly are very sensitive to?
Anticholinergics
(Atropine, scopolamine)
57
What is a class of medications that the elderly are very sensitive to?
Anticholinergics
(Atropine, scopolamine)
58
Cognitive dysfunction/problems appear how long after surgery?*****
weeks-months
(OLD AGE puts someone at the greatest risk for cognitive dysfunction) **** ORTHO SURGERY (#2)
59
What makes the skin prone to tearing?
Skin atrophy
(Watch tape, bovie pads, and electrodes
60
What are pharmacokinetics?
The relationship btwn drug dose and plasma concentrations.
61
What are pharmacodynamics?
the relationship btwn plasma concentrations and clinical effects
62
What will affect the volume of distribution of drugs?
Decrease in muscle mass and increase in body fat
63
Is total body water increased of decreased in the elderly?
Decreased
64
What kinds of drugs will have higher plasma concentrations?
Water-soluble drugs (d/t reduced volume)
A decrease in total body water=lower volume of distribution for hydrophilic drugs
65
Will fat-soluble drugs have an increased or decreased volume of distribution?
Increased
66
A patient will have a more rapid onset of inhalational anesthetic if their ______ _____ is decreased
cardiac output
(myocardial depressant effects will be exaggerated, while tachycardic response will be decreased
67
Why will an elderly pt have a longer wake up time from anesthesia?
D/t increased body fat (liver enzymes don't change**)
decreased hepatic function
decreased pulmonary gas exchange
68
Why will an elderly pt have a longer wake up time from anesthesia?
D/t increased body fat (liver enzymes don't change**)
decreased hepatic function
decreased pulmonary gas exchange
69
Things that don't change in the geriatric population:***
Liver/hepatic enzymes and systolic function****
70
What drug categories do you need lower doses of?
- Barbiturates
-opioids
-benzos
71
What class of drugs will your dosing NOT change for elderly?
Muscle relaxants
(prolonged DOA though d/t decreased renal function)
72
What kind of drugs does albumin bind?
Acidic drugs (decreases slightly)
73
What kind of drugs does alpha-1 glycoproteins (AAG) bind?
Basic drugs (increases)
binds local anesthetics and opioids
74
What is Progeria?
AKA: Hutchinson-Gilford Syndrome (premature aging)
-Apparent after 6 mon. of age
-s/s: ischemic heart disease, osteoarthritis, CV disease, HTN, DM
-average age: 13
-mandubular hypoplasia (underdevelopment)
-micrognathis (micromandible)
-narrow glottic opening
75
Match the physiologic characteristic with the manner in which it changes with age.
A.) insulin resistance
B.) CNS activity
C.) total lung capacity
1.) increases
2.) decreases
3.) stays the same
Insulin resistance= increases
CNS activity= Decreases
Total lung capacity= unchanged
CNS activity decreases with age. Serum albumin decreases slightly with age. Although residual volume increase and vital capacity decreases, the total lung capacity remains unchanged. Elderly patients exhibit a lower insulin response to glucose loads as well as increased insulin resistance in skeletal muscle.
76
Which change is principally responsible for the reduction in alveolar surface volume in the elderly?
A. Osteoporosis in the spinal column
B. Inflexibility of the rib cage
C. COPD
D. Decreased pulmonary elastic tissue
D. Decreased pulmonary elastic tissue
The alveolar surface area available for gas exchange is reduced in the elderly. The cause is an overall reduction in elastic tissue in the lungs.
77
The elimination of hydrophilic agents in the elderly is prolonged primarily because of
A. a decrease in hepatic blood flow
B. a decrease in renal clearance
C. a decrease in volume of distribution
D. a decrease in serum pH
B. a decrease in renal clearance
The elimination of hydrophilic agents is prolonged in the elderly primarily due to a decrease glomerular filtration rate and decreased renal blood flow.
78
Which of the following characteristics do geriatric patients share with neonates?
A. A higher body surface area to body mass ratio
B. A higher relative concentration of body water
C. Decreased alpha-1 acid glycoprotein levels
D. Increased skeletal muscle mass
A. A higher body surface area to body mass ratio
Both classes of patient have a high body surface area to body mass ratio. Although neonates have a higher concentration of body water, geriatric patients have a lower proportion of body water. Although neonates can have a lower alpha-1 acid glycoprotein level than adults, this value is either normal or slightly elevated in geriatric patients.
79
Match the respiratory parameter and the change you would expect to occur as a result of increased age.
A.) FEV1
B.) Closing Volume
C.) Total lung capacity
1.) Increase
2.) Decrease
3.) No change
FEV1= Decrease
Closing Volume= increase
Total lung capacity= no change
The closing volume is increased in the elderly patient. Functional residual capacity also increases with age due to an increase in residual volume. The total lung capacity decreases slightly or is unchanged. The loss of elastic recoil around the alveoli results in a decrease in the forced vital capacity and FEV1.
80
Which of the following tests of renal function would you expect to be unchanged by advanced age?
A. Glomerular filtration rate
B. Renal blood flow
C. Creatinine
D. Creatinine clearance
C. Creatinine
Due primarily to fibrotic changes and decreased mass in the renal cortex, glomerular filtration rate and creatinine clearance decrease with age. Even though creatinine clearance decreases, the reduced muscle mass and creatinine production associated with increased age result in an unchanged serum creatinine level.
81
Which of the following changes are expected to occur in the elderly as part of the normal aging process? (select two)
A. Hepatic microsomal activity is decreased
B. Pulmonary collagen content increases
C. Renal blood flow decreases
D. The alveolar-arterial difference for oxygen decreases
B. Pulmonary collagen content increases
C. Renal blood flow decreases
Although hepatic and renal blood flow both decrease, hepatic microsomal enzyme activity is generally well preserved in the elderly. The effect of aging on the pulmonary system is a decrease in elastic tissue and an increase in the amount of collagen resulting in a 15% reduction in the functional alveolar surface area. The alveolar-arterial difference for oxygen increases from approximately 8 mm Hg at age 20 to approximately 20 mm Hg at age 70.
82
Many changes in organ function and composition occur by the eighth decade of life. Match the appropriate change with the organ system change or diagnostic characteristic with which it is associated.
A.) Serum creatinine concentration
B.) Brain Mass
C.) Plasma catecholamine levels
1.) Increase
2.) Decrease
3.) Stays the same
serum creatinine concentration = Stays the same
Brain mass= decreases
Plasma catecholamine levels= increases
83
All of the lung parameters below increase with age except for
A. Closing capacity
B. Functional residual capacity
C. Total lung capacity
D. Residual volume
C. Total lung capacity
The total lung capacity doesn't change significantly due to age alone. Functional residual capacity increases due to an increase in residual volume. The closing volume and closing capacity eventually increase to such an extent, however, that they exceed functional residual capacity.
84
Which of the following drugs would not exhibit a smaller volume of distribution in the geriatric patient?
A. Glycopyrrolate
B. Succinylcholine
C. Diazepam
D. Gentamicin
C. Diazepam
In the elderly patient, total body water decreases while total body fat increases. Thus, the volume of distribution for water-soluble drugs such as glycopyrrolate, succinylcholine, and gentamicin decreases while the volume of distribution for lipid-soluble drugs such as barbiturates, benzodiazepines, and volatile anesthetics increases.
85
Which of the following responses to induction would you expect to occur in the elderly?
A. Slower inhalation induction
B. Increased tachycardic response to hypotension
C. Increased tachycardic response to hypoxia
D. Slower intravenous induction
D. Slower intravenous induction
The elderly exhibit a prolonged circulation time which results in a faster inhalation induction and a slower intravenous induction time. Similar to infants, the elderly have a diminished tachycardic response to hypotension, hypovolemia, or hypoxia.
86
What is one reason many geriatric patients are more susceptible to hypothermia?
A. They are more prone to hypothyroidism
B. The have a lower body surface area to body mass ratio
C. They have a higher basal metabolic rate
D. They have an increase in lean muscle mass
A. They are more prone to hypothyroidism
Geriatric patients are more susceptible to hypothermia because they have a lower basal metabolic rate, a higher incidence of hypothyroidism, a high proportion of body surface area to body mass, and their ability to produce peripheral vasoconstriction to reduce heat loss is not as effective.
87
All of the following physiologic parameters decrease in the elderly except
A. Closing volume
B. Renal mass
C. Lean body mass
D. Body water
A. Closing volume
88
Which of the following respiratory parameters is decreased in elderly patients?
A. Alveolar surface area
B. Residual volume
C. Closing capacity
D. Both A and B
A. Alveolar surface area
In the elderly patient, closing capacity increases, and by age 65 it exceeds tidal volume in the sitting position resulting in airway collapse. The increase in airway collapse increases residual volume as well. The alveolar surface area decreases with age resulting in decreased efficiency of gas exchange.
89
Hypothermia in the elderly is known to increase the risk for (select two)
A. myocardial ischemia
B. surgical wound evisceration
C. coagulopathy
D. surgical necrosis
A. myocardial ischemia
C. coagulopathy
Temperature regulation is impaired in elderly patients. Shivering can increase oxygen consumption and lead to hypoxia, acidosis, and cardiopulmonary complications rapidly in elderly patients. Drug metabolism can be impaired with hypothermia, as can platelet function, and the risk for infection is greater.
90
Which of the following statements is true of the pharmacokinetic changes seen in the elderly population?
A. They have a higher volume of distribution for succinylcholine
B. They have a lower volume of distribution for glycopyrrolate
C. They have a lower volume of distribution for thiopental
D. They have a lower volume of distribution for midazolam
B. They have a lower volume of distribution for glycopyrrolate
In the elderly patient, total body water decreases while total body fat increases. Thus, the volume of distribution for water-soluble drugs such as glycopyrrolate, succinylcholine, and gentamicin decreases while the volume of distribution for lipid-soluble drugs such as barbiturates, benzodiazepines, and volatile anesthetics increases.
91
Which of the following statements accurately explains why geriatric patients have higher insulin requirements perioperatively?
A. They exhibit a lower insulin response to glucose loads
B. They exhibit decreased insulin resistance in skeletal muscle
C. They have decreased hepatic mass
D. They are most likely already taking insulin
A. They exhibit a lower insulin response to glucose loads
Elderly patients tend to have higher insulin requirements perioperatively, even when a diagnosis of diabetes is not present. They exhibit a lower insulin response to glucose loads as well as increased insulin resistance in skeletal muscle.
92
The elimination of hydrophilic agents in the elderly is prolonged primarily because of
A. a decrease in hepatic blood flow
B. a decrease in renal clearance
C. a decrease in volume of distribution
D. a decrease in serum pH
B. a decrease in renal clearance
The elimination of hydrophilic agents is prolonged in the elderly primarily due to a decrease glomerular filtration rate and decreased renal blood flow.
93
The geriatric population is more susceptible to decreases in core temperature primarily because
A. basal metabolic rate increases with age
B. decreased body fat results in increased heat loss
C. autonomic peripheral vasoconstriction decreases with age
D. they exhibit increased lean body mass
C. autonomic peripheral vasoconstriction decreases with age
The elderly population is more susceptible to decreases in core temperature primarily due to a decrease in basal metabolic rate and decreased autonomic peripheral vasoconstriction. Elderly patients have an increased body fat reserve.
94
Highly protein-bound drugs display a higher concentration of the free form of the drug in the elderly population. Why is this?
A. Elderly patients have an increase in the pulmonary uptake of drugs
B. Elderly patients have lower albumin levels
C. Elderly patients have increased renal mass
D. Elderly patients have increased skeletal muscle blood flow
B. Elderly patients have lower albumin levels
Overall, plasma protein-binding is decreased in the elderly population. This is due to a decrease in circulating albumin levels. Alpha-1 acid glycoprotein levels, however are unchanged.
95
The increase in peripheral vascular resistance seen in elderly patients typically results in
A. Hypotension
B. Eccentric left ventricular hypertrophy
C. Concentric left ventricular hypertrophy
D. Increased cardiac output
C. Concentric left ventricular hypertrophy
The increase in peripheral vascular resistance (afterload) in the elderly occurs primarily due to progressive loss of arterial distensibility and leads to concentric left ventricular hypertrophy. The cardiac output may decrease due to myocardial fiber atrophy, but as the increase in afterload is greater than the decrease in cardiac output, hypertension usually results.
96
All of the lung parameters below increase with age except for
A. Closing capacity
B. Functional residual capacity
C. Total lung capacity
D. Residual volume
C. Total lung capacity
The total lung capacity doesn't change significantly due to age alone. Functional residual capacity increases due to an increase in residual volume. The closing volume and closing capacity eventually increase to such an extent, however, that they exceed functional residual capacity.
97
Which of the following tests of renal function would you expect to be unchanged by advanced age?
A. Glomerular filtration rate
B. Renal blood flow
C. Creatinine
D. Creatinine clearance
C. Creatinine
Due primarily to fibrotic changes and decreased mass in the renal cortex, glomerular filtration rate and creatinine clearance decrease with age. Even though creatinine clearance decreases, the reduced muscle mass and creatinine production associated with increased age result in an unchanged serum creatinine level.
98
Which of the following is not decreased in elderly patients?
A. Aldosterone secretion
B. Blood volume
C. Circulatory time
D. Glomerular filtration rate
C. Circulatory time
The circulatory time is increased in the elderly. As a result, intravenous induction will progress more slowly as it takes longer for the administered drugs to reach their target sites. The glomerular filtration rate decreases about 1 mL/min each year after age 40. Blood volume decreases with age. In elderly patients, the kidneys are not as effective at eliminating excess sodium, nor are they as effective at retaining sodium. This is due primarily to a reduction in the secretion of aldosterone.
99
A drug with a high hepatic extraction ratio may exhibit a prolonged elimination half-life in an elderly patient because:
A. Hepatic mass decreases with age
B. Hepatic transaminase levels increase with age
C. Cytochrome P450 activity diminishes with age
D. Hepatic blood flow diminishes with age
D. Hepatic blood flow diminishes with age
Hepatic transaminase levels and hepatic enzyme activity do not normally change with increased age. Hepatic mass does decrease with age, but the clearance of drugs with a high hepatic extraction ratio relies on hepatic blood flow not hepatic mass. Hepatic blood flow decreases by as much as 40% by 80 years of age.
100
The decreased ability to retain or eliminate sodium in elderly patients is partially attributed to reductions in
A. aldosterone secretion
B. diuretic use
C. cognitive ability
D. norepinephrine levels
A. aldosterone secretion
The ability of the kidneys to retain or eliminate sodium is affected as a person ages. Age related reductions in aldosterone secretion partly explain the reduced ability to retain sodium.
101
Elderly patients have
A. decreased sympathetic activity at rest
B. a decreased systolic blood pressure
C. a diminished cardiac response to beta-receptor stimulation
D. an increase in the number of sinus node pacemaker cells
C. a diminished cardiac response to beta-receptor stimulation
Elderly patients have a diminished cardiac response to beta-receptor stimulation and increased sympathetic activity at rest. The number of sinus node cells decreases with age.
102
Which of the following increases as a result of the aging process?
A. Catecholamine levels
B. Parasympathetic activity
C. Response to beta receptor stimulation
D. The efficacy of baroreflex control of blood pressure
A. Catecholamine levels
As a result of aging, the response to beta-receptor stimulation and parasympathetic activity decrease. Serum catecholamine levels increase as a result of aging. Efficacy of blood pressure control by the baroreflex decreases with age.
103
With age, renal cortical mass decreases by as much as
A. 15 percent
B. 25 percent
C. 35 percent
D. 45 percent
B. 25 percent
The mass of the renal cortex lowers by 20-25 percent with age. Also, by age 80 approximately half of the glomeruli are lost.
104
With aging, the ventilatory response to hypercapnia can decrease by as much as _____ percent.
A. 10
B. 30
C. 50
D. 70
C. 50
With aging, the ventilatory response to hypercapnia decreases by as much as 50 percent.
105
Which of the following contribute to the prolonged elimination half-life of many drugs in geriatric patients? (select two)
A. Decreased vascular volume
B. Decreased renal blood flow
C. Increased lipid stores
D. Decreased alpha-1 acid glycoprotein levels
B. Decreased renal blood flow
C. Increased lipid stores
Geriatric patients have increased adipose stores, which prolongs the action of lipid-soluble drugs. They also have decreased hepatic and renal blood flow which can prolong the action of drugs dependent on the liver and kidneys for elimination. Although they have a decreased vascular volume, this correlates with a higher initial plasma concentration of a drug, not a prolonged elimination half-life. Alpha-1 acid glycoprotein levels normally are not affected by aging.
106
You are concerned about the postoperative fluid status of an elderly patient with a history of congestive heart failure. On what postoperative day would you expect third space fluid to mobilize into the vascular system?
A. 1
B. 2
C. 3
D. 4
B. 2
Third-space fluid begins to mobilize into the vascular space on postoperative day two. It is important to evaluate the elderly patient for signs of fluid volume excess such as rales, crackles, tachypnea, and orthopnea.
107
Many central nervous system neurotransmitters decline with age. Which one is most closely associated with the development of Alzheimer's disease?
A. acetylcholine
B. GABA
C. dopamine
D. serotonin
A. acetylcholine
CNS concentrations of dopamine, serotonin, GABA, and acetylcholine all decrease with age. Acetylcholine is the most significant as it is linked with the development of Alzheimer's disease.
108
Which of the following statements regarding metabolic function in the elderly is true?
A. Maximal oxygen consumption increases with age
B. Circulating catecholamine levels decrease with age
C. Insulin resistance decreases with age
D. Elderly patients have a decreased response to beta-adrenergic agents
D. Elderly patients have a decreased response to beta-adrenergic agents
Elderly patients have a decreased response to beta-adrenergic agents and an increase in circulating catecholamine levels. Maximal oxygen consumption decreases with age and insulin resistance increases, resulting in a decreased ability to handle glucose loads.
109
A one degree reduction in skin temperature correlates to an approximate ___ degree reduction in core body temperature.
A. 0.2
B. 1
C. 2
D. 5
A. 0.2
When exposed to a cold environment, there is a reduction in core and/or skin temperature. (A 1 degree reduction in skin temperature is equal to an approximate 0.2 degree reduction in core body temperature.)
110
The decrease in total body water that occurs with aging is primarily due to
A. A decrease in blood volume
B. A decrease in muscle mass
C. A decrease in cerebrospinal fluid
D. A decrease in adipose tissue
B. A decrease in muscle mass
Total body water decreases with age, primarily due to the decrease in cellular water from the loss of muscle mass and increase in adipose tissue.
111
Which of the following statements describes the age-related changes in glomerular function accurately?
A. Dosing adjustments based on renal function do not need to be made until about age 70
B. The glomerular filtration rate decreases by 1 mL/min each year after age 40
C. By age 80, over 75% of the glomeruli are lost
D. The glomerular filtration rate does not appreciably change with age
B. The glomerular filtration rate decreases by 1 mL/min each year after age 40
The glomerular filtration rate decreases about 1 mL/min each year after age 40. This can reduce renal excretion of drugs to a level where dosing adjustments need to be made by age 60. By age 80, over half of the glomeruli are lost.
112
Most of the decrease in hepatic blood flow associated with aging is due to
A. Decreased parasympathetic activity
B. Peripheral vascular disease
C. Fatty infiltration of the liver
D. Decreased liver mass
D. Decreased liver mass
Liver mass decreases with age and accounts for most of the 20-40% decrease in hepatic blood flow with age.
113
What surgical procedure has the highest risk for postoperative delirium in elderly patients?
A. Orthopedic surgery
B. Laparoscopic surgery
C. Transurethral resection of the prostate
D. Lithotripsy
A. Orthopedic surgery
Although postoperative delirium can occur following any type of surgical procedure, it is most common in orthopedic surgery. Up to 35% of elderly patients undergoing orthopedic surgery experience delirium.
114
Which issues would you expect to see in a geriatric patient? (select two)
A. Problems eliminating excess sodium
B. Problems retaining sodium
C. Decreased alpha-1 acid glycoprotein levels
D. Increased serum albumin levels
A. Problems eliminating excess sodium
B. Problems retaining sodium
In elderly patients, the kidneys are not as effective at eliminating excess sodium, nor are they as effective at retaining sodium. This is due primarily to a reduction in the secretion of aldosterone. Serum albumin decreases slightly with age, but alpha-1 acid glycoprotein levels are usually unchanged or even experience a slight increase.
115
The Triple-Low effect associated with an increased risk for complications in the elderly includes all of the following except
A. low blood pressure
B. low volatile anesthetic concentration
C. low BIS value
D. low heart rate
D. low heart rate
One anesthesia-associated risk factor associated with increased risk for complications is the 'triple-low' effect. Patients who undergo anesthesia during which they have a low concentration of inhaled anesthetic, a low blood pressure, and a low BIS value (a deep hypnotic state) are at an increased risk for longer hospital stays and a higher one-month mortality rate. This may be less of a causative effect, however, and more of an indicator of the low functional reserve of the patient.
116
An elderly patient describes exhaustion, significant weight loss in the past year, weakness, and a low physical activity level. These are all defining characteristics of
A. senile dementia
B. frailty
C. renal dysfunction
D. coronary artery disease
B. frailty
One method of defining frailty is as a syndrome in which at least three of the following criteria are met: unintentional weight loss of more than 10 lbs in the past 12 months, exhaustion, weakness, slow walking speed, and a low physical activity level.
117
Which agent would be appropriate for the treatment of delirium and agitation in a patient in the intensive care unit?
A. Dexmedetomidine
B. Haloperidol
C. Midazolam
D. Valium
B. Haloperidol
Haloperidol is an antipsychotic agent that doesn't exhibit any significant alpha-adrenergic activity. The principal use of haloperidol is the treatment of delirium and agitation in the intensive care unit.
118
The glomerular filtration rate (GFR) decreases by approximately ____ ml/min/year after age 40.
A. 1
B. 2
C. 3
D. 4
A. 1
After age 40, GFR lowers approximately 1 mL/min/year after age 40.
119
Which lung volumes and capacities INCREASE?
-Closing capacity
-Residual volume
-Functional residual capacity
120
Which lung volumes and capacities DECREASE?
-Expiratory reserve volume
-Vital capacity
-FEV & FEV1
-inspiratory reserve volume
121
Which lung capacity remains unchanged?
Total lung capacity
122
How much does GFR decrease?
by 1 mL/min/year after age 40
